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Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis.

Bruns H, Lozanovski VJ, Schultze D, Hillebrand N, Hinz U, Büchler MW, Schemmer P - PLoS ONE (2014)

Bottom Line: While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist.With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.

ABSTRACT

Background and aims: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality.

Methods: Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed.

Results: A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na+>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).

Conclusions: In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

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Related in: MedlinePlus

Patient Allocation.Of 429 patients who underwent liver transplantation at our institution from December 2006 till March 2011, 266 were eligible for inclusion in the study. *incl. 18 HU-listed, 33 split/living related, and 5 retransplantations; excl. **<18 years; ***<18 years or HU-listed; ****<18 years, HU-listed or split/living related or combined organ transplantation.
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pone-0098782-g001: Patient Allocation.Of 429 patients who underwent liver transplantation at our institution from December 2006 till March 2011, 266 were eligible for inclusion in the study. *incl. 18 HU-listed, 33 split/living related, and 5 retransplantations; excl. **<18 years; ***<18 years or HU-listed; ****<18 years, HU-listed or split/living related or combined organ transplantation.

Mentions: All national and institutional guidelines and regulations concerning data acquisition in retrospective analyses were followed at all times. After obtaining approval from the local ethics committee (Ethikkommission der Medizinischen Fakultät Heidelberg, Heidelberg, Germany; reference number: S-548/2012), the study was conducted with all patients who underwent liver transplantation at the University of Heidelberg from the establishment of MELD-based allocation in December 2006 until March 2011. According to the approval statement by the local ethics committee, no consent was needed for this single-center analysis. Only persons who were at least 18 years of age were included in the study. High urgency listed patients and persons who underwent living donor, split liver, combined or re-transplantations were excluded from the analysis. Of the 429 patients who had undergone liver transplantation procedures, 266 were eligible for inclusion in the study (Figure 1).


Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis.

Bruns H, Lozanovski VJ, Schultze D, Hillebrand N, Hinz U, Büchler MW, Schemmer P - PLoS ONE (2014)

Patient Allocation.Of 429 patients who underwent liver transplantation at our institution from December 2006 till March 2011, 266 were eligible for inclusion in the study. *incl. 18 HU-listed, 33 split/living related, and 5 retransplantations; excl. **<18 years; ***<18 years or HU-listed; ****<18 years, HU-listed or split/living related or combined organ transplantation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048202&req=5

pone-0098782-g001: Patient Allocation.Of 429 patients who underwent liver transplantation at our institution from December 2006 till March 2011, 266 were eligible for inclusion in the study. *incl. 18 HU-listed, 33 split/living related, and 5 retransplantations; excl. **<18 years; ***<18 years or HU-listed; ****<18 years, HU-listed or split/living related or combined organ transplantation.
Mentions: All national and institutional guidelines and regulations concerning data acquisition in retrospective analyses were followed at all times. After obtaining approval from the local ethics committee (Ethikkommission der Medizinischen Fakultät Heidelberg, Heidelberg, Germany; reference number: S-548/2012), the study was conducted with all patients who underwent liver transplantation at the University of Heidelberg from the establishment of MELD-based allocation in December 2006 until March 2011. According to the approval statement by the local ethics committee, no consent was needed for this single-center analysis. Only persons who were at least 18 years of age were included in the study. High urgency listed patients and persons who underwent living donor, split liver, combined or re-transplantations were excluded from the analysis. Of the 429 patients who had undergone liver transplantation procedures, 266 were eligible for inclusion in the study (Figure 1).

Bottom Line: While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist.With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.

ABSTRACT

Background and aims: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality.

Methods: Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed.

Results: A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na+>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).

Conclusions: In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

Show MeSH
Related in: MedlinePlus